Wiki Urine drug test reimbursement

[MLVaughan0986]

My manager would like to know what codes she would use to get a urine drug test reimbursed for Medicare, Medicaid, and commercial plans?
She uses Millennium.

Thank you,

Maggie

 

[Cavalier40]

There are 3 presumptive urine drug screen codes
80305 is a point of care cup, or just an optical observation
80306 is a machine assisted optical observation test (5 years in SUD treatment and I still have never seen a test like this)
80307 is a high complexity machine test with paper results.

Most practices will just use the point of care unless they have a COLA license and money for the machine and reagents.

Medicaid codes may be different depending on state and if you are submitting to an MCO or a MH/SA carve out. For example Medicaid OH will require H0048 while Medicaid of MD will accept the CPT codes.

Hope this helps

 

[MLVaughan0986]

urine Test Reimbursement

Thank you these are the codes I found online and in one of the monthly magazines so hopefully this will work for her.

Thank you,

Maggie

 

[MLVaughan0986]

Urine Test Reimbursement

Hello,

I was wondering if anyone had any other advice that can help my manager get reimbursed for a urine drug test? She is a primary family care APRN in Connecticut. She has used codes 80305, 80306, and 80307. Do you know any other reasons insurance companies would not be paying these services for her?

Thank you,

Maggie

 

[Cavalier40]

First I would make sure you are testing for the correct presumptive test. If you are using 80306 or 80307 you are probably going to need a laboratory COLA license (more so the 80307, I am not sure on the 80306). The 80305 requires a CLIA waiver

Next is that due to the drug treatment industries misuse of urine drug screen billing, many payers have limitations on presumptive and definitive drug screens. For example:

Aetna allows 8 per 12 months (rolling)
Cigna allows 32 per calendar year
Florida Blue allows 15 per calendar year
Highmark BCBS allows 4 high complexity and 12 POC cups per year.

Quite possibly they have exhausted their limit and that is causing denials.

I have not billed these to Medicare so I am not sure if they have a restriction on mid level providers ordering the lab.

I can also probably better answer the question if you can give me examples of specific denials.

 

[tsteuerwald]

Urine Drug Test- Billing Logistics (provider supervising collection- not reading it)

In the circumstance of the physician supervising the collection of the urine (via point of care cup), but not performing the actual 'urinalysis', is there any way for him to bill this out?

Are there restrictions based on physician licensure?

 

[CodingKing]

In the circumstance of the physician supervising the collection of the urine (via point of care cup), but not performing the actual 'urinalysis', is there any way for him to bill this out?

Are there restrictions based on physician licensure?

99000 but most payers don't reimburse.

 

[tsteuerwald]

Urinalysis-- Confirmations?

99000 but most payers don't reimburse.

Now that I've given this info to the group, they are back on the 80305 train. They do have a CLIA Waiver, so we may be on the right path.

However, they are interested in running the sample via dipstick for the 80305, then intend to send that same sample to a lab for confirmation, which is also going to bill the patient after running that same sample.

This doesn't seem appropriate to me (At least not on 100% of samples- it would be one thing to run a more detailed/quantitative test if the dipstick came back positive, but 100% of samples can't seriously be sent for 'confirmation'.. can it?)

Can someone help me locate the literature that defines if or if not this is a viable option?? I need to get the chapter/verse to our provider for review.

 

[jhendrix08]

We used Millennium in the past and they were helpful with providing billing support; I would contact them directly. You should have a rep assigned directly to your office.